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0248/04 - 02:02pm P. -002 <br /> r <br /> Waste Prof <br /> ile'# <br /> V. PHYSICAL CHARACTERISTICS OF WASTE <br /> CHARACTERISTIC COMPONENTS % BY WEIGHT lrangg) <br /> 2. <br /> 3 <br /> t'oior. or(describe):, Free Liquids: %Solids: pH: Flasli ' Phenol <br /> YES or NO Point' <br /> Content % � dt <br /> "F. ppm.` <br /> -.... _.. Attach Laboratory Analytical Report(and 4 ir Material Safety Data.Sheet) <br /> Including,Required Parameters Pr 7videdfor this Profde <br /> :Does this waste or generating process contain regulated concentrations the following Pesticides <br /> anchor Herbicides: Chlordane,Endrin,heptachlor(and its epoxides), Lir dane,Methoxychlor, YES' of <br /> Toxaphene,2, 4-1),2, 4,5,-TP S ilvex as defined in §40 CFR 261.33'7 <br /> Does this waste or generating process cause it to exceed OSHA exposurf limits from high levels of - <br /> Hydrogen Sulfide or Fiydrogen Cyanide as defined in'"§4o CTR 261.23? <br /> YES. or N <br /> Does'this waste contain regulated concentrations of Polychlorinated Bipl enyls(PCBs)as defined in <br /> 40 CFR Pati 761? YES or NO� <br /> Does this waste contain regulated concentrations of listed hazardous:w Les defined by §40 CFR YES or t7 <br /> 261:3-1,261.32;261.._"33, including RCRA F-Listed Solvents? <br /> Does this waste-contain.regulated concentrations of 2,3,7, R -Tetrachlor c0benzodioxin(2, 3,7,R - YES or <br /> TCCD),or any other dioxin as defined in§ 40 CRF 261.31? . <br /> Is this a regulated Toxic.Material as defined by Federal andlor State regi lations? YES.or N <br /> Is this a regulated Radioactive Waste as defined by Federal and/or State egulations? YES'. or. <br /> Is this a regulated Medical or Infectious Waste as defined by Federal itnc or State regulations? YES <br /> Is this waste generated at a Federal Superfund Clean Up Site? YES o NO <br /> VT. GENERATOR CERTIFICATION <br /> 1 hereby certify that to the best of nay knowledge and belief, the informai ion contained herein is a true and acurate description of,the <br /> waste material being offered for disposal. I further certify that by utiliziing this profile, neither myself nor any other employee of the <br /> company will deliver for disposal or attempt to deliver for disposal any waste which is classified as toxic-waste,:hazardous waste, <br /> medical or infectious waste,or any other waste material this facility is prohibited from accepting by law.Our company hereby agrees <br /> to fully indemnify this dispo: facility ainst ry damages resulting frorn this certification bein itiaccurat or mnlrruee..' <br /> _ LCI C:i <br /> AL� IZ>;D PR SENTATIVB NA AND TI"1'LL�(Printed) C MPANY NAM <br /> AUTHOR D REPRESENTATIVE SIGNATURE DATE. <br /> :VII,.. : ALLIED WASTE DECISION <br /> Approved Dejected <br /> Expiration. <br /> Conditions: <br /> Name,Title Signature Date <br />